Breastfeeding with psoriatic disease? Four things to keep in mind

| Patricia Olney

You survived pregnancy and brought a new life into the world – congratulations! But if you’re living with psoriatic disease, you may still have some questions, such as “Can I breastfeed my baby while treating my psoriasis/psoriatic arthritis?” and “What happens if (or when) I have a flare-up of my symptoms?”

The first step is to consult a professional who is knowledgeable about the treatment of psoriasis/psoriatic arthritis. Internet chat rooms are not the place to go for accurate information. Unfortunately, many women are needlessly discouraged from breastfeeding when faced with an illness that makes it difficult to nurse their newborn.  

Here are some tips:

Most medications are OK while breastfeeding

According to a policy statement made by the American Academy of Pediatrics, “there are very few medications that should not be used in treating women during breastfeeding.”1

It is rarely required that a woman discontinue breastfeeding just to take a medication. For one thing, many medications don’t make their way into breast milk. For example, because Humira (adalimumab) and Enbrel (etanercept) are made from very large proteins, they are unlikely to pass in large amounts from a woman’s bloodstream into her breast milk. Although there have been very few published studies, it is generally thought that even if medications such as adalimumab or etanercept do pass to the nursing infant, the infant’s digestive system may not be able to absorb the drug. Thus, the amount that gets into the infant’s bloodstream would not be likely to affect him/her.  

If your baby was born before 37 weeks, be sure to discuss breastfeeding options with your healthcare provider. Preterm infants may have less mature digestive systems, and could be more susceptible to small amounts of drugs in milk because they are not able to eliminate drugs as well as full-term infants.

If you’re having a flare-up after delivery, don’t panic.

Some women experiencing a flare-up may become discouraged from nursing because of painful, cracked nipples. An over-the-counter, water-washable moisturizer or emollient may help ease the dryness-- but avoid greasy ointments. If a low-dose topical corticosteroid, such as hydrocortisone or triamcinolone, helped you before delivery, you may use it cautiously, but wipe the cream from your nipples and areola before nursing. You may want to consider pumping or manually expressing your breast milk until your nipples heal.

Touch base with your healthcare provider 

Ultraviolet light B (UVB) treatment is considered acceptable during breastfeeding, but ultraviolet A with psoralen [PUVA] is not. An infant whose mother is treated with cyclosporine should be closely monitored, possibly including monitoring drug levels in the infant’s blood.

The use of methotrexate is usually not recommended during breastfeeding, but some experts feel that low weekly doses might be acceptable.2

The use of topical Retin-A (tretinoin) directly on the skin is compatible with breastfeeding since very little to none is absorbed into the mother’s bloodstream. However, it should not be applied to the breast and treated skin should not come in contact with the infant’s skin.  

Where can I get more information?

The National Psoriasis Foundation provides a guide for the use of medications during pregnancy and breastfeeding.

And when in doubt, you can always call a MotherToBaby counselor. We’re here to answer your questions, and our service is FREE and confidential. Call us toll-free at (866) 626-6847.

In addition, MotherToBaby’s website has FREE fact sheets about some of the medications prescribed during pregnancy and breastfeeding to treat psoriasis/psoriatic arthritis. Pregnancy risk specialists write these fact sheets based on evidence from well-designed research studies. We currently have fact sheets for Humira (adalimumab), Cimizia (certolizumab pegol), Enbrel (etanercept), and Stelara (ustekinumab).

Last, new apps have been developed to provide information about medication safety while breastfeeding; these include MommyMeds, a pregnancy safety guide from Texas Tech University Health Sciences Center, which costs $3.99 to download and LactMed by National Library of Medicine,” which is free.



Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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